Fourteen patients with pelvic recurrence of rectal carcinoma and sigmoid were treated principally for pain relief using external beam radiotherapy. 10 MV X-ray treatment was applied to the pelvic region with varying dose levels (30-54 Gy); as a boost, electron beam or ⁶⁰Co irradiation was delivered to perineal region for 7 patients. All patients had a good or moderate symptomatic response to radiotherapy; the 2-year survival was 33.9% and, for 9 patients without distant metastases, it was 57.6%; no severe radiation injuries occurred. From our study, it was concluded that radiotherapy should be considered for most patients with symptomatic local recurrence.

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Nine patients with T4 (A₃) esophageal cancer were treated with 192-Iridium (¹⁹²Ir) brachytherapy following resective surgery between February 1988 and January 1989. None of the primary tumors invading the tracheo-bronchial system, aortic wall and mediastinum (6, 2 and 1 cases, respectively) were completely surgically resected. The tubes used for 192Ir brachytherapy were intraoperatively placed close to the residual tumor sites.D oses of 30 Gy were planned for the ¹⁹²Ir brachytherapy with external irradiation of 50 Gy also scheduled. Five patients received the total planned dose, but brachytherapy-induced complications-healed with conservative treatment-were observed in 1 patient. As ofM arch 1989, two had not survived and seven recovered without local recurrence. The method was considered safe and effective for the local control of advanced esophageal cancer following resective surgery.

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Seventy-three patients with squamous cell carcinoma of the head and neck were treated with radiotherapy at Tokyo Women's Medical College from 1968 until 1985. The 135 metastatic cervical lymph nodes were given radiation doses exceeding TDF 65 (40 Gy/20 fr/4 weeks). The data was analyzed retrospectively to evaluate the factors affecting radiation response and control. 1) At 1 month following radiotherapy, the complete response (CR) rate was 102/135 (76%), partial response (PR) was 23/135 (17%), 6/135 (4%) registered no change (NC), and 4/135 (3%) exhibited progressive disease (PD). 2) The CR rate for nodes near the primary site was 65/68 (96%) for nasopharynx, 12/15 (80%) oropharynx, 13/21 (62%) for hypopharynx, 0/7 for tongue, 8/17 (47%) for larynx, and 4/7 for maxillary sinus, respectively. 3) The CR rate was 81/98 (83%) for lymph nodes up to 3 cm compared to 21/37 (58%) for larger nodes. In nasopharyngeal carcinoma, the CR rate for nodes up to 3 cm was 30/30 (100%) at dose levels over TDF 65; however, for larger nodes, it was 4/7 (57%) at TDF 65-99 and 10/10 (100%) at TDF 100 or above. In other carcinomas, the CR rate for nodes up to 3 cm was 13/23 (57%) at 65-99 and 17/24 (71%) at TDF 100 or ab ove; however, for larger nodes, it was 0/2 at TDF 65-99 and 7/18 (39%) at TDF 100 or above. 4) In moderately and well differentiated carcinomas, the CR rate was related to TDF. 5) In follow-up studies, 8 of 102 CR nodes recurred and were accompanied by primary and/or distant disease; 5 out of 23 PR nodes changed to CR 2-12 months after treatment. 6) The 2-year CR rate for nasopharyngeal carcinoma nodes was 19/28 (68%) and 15/42 (36%) in the other nodes. The data suggests that, for patients with metastatic lymph nodes from squamous cell carcinoma of the head and neck, radiotherapy was effective and useful in curing nodes up to 3 cm, irrespective ofth e primary site or histological grade. However, with the exception of nasopharyngeal carcinoma, multimodal treatment should be considered for nodes larger than 3cm.

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Forty-five patients with squamous cell carcinoma of the alveolus and gingiva were treated at the Department of Radiology, Tokushima University Hospital between 1976 and 1987. The 30 male and 15 female patients had a median age of 62.7 years (age range; 32-88 years); according to the 1987 TNM classification, one had Stage I disease, five had Stage II, four had Stage III, and 35 had Stage IV. Eleven patients were treated with radiotherapy alone, 15 with radiotherapy + immunochemotherapy, 6 with surgery+ radiotherapy, and 13 with surgery + radiotherapy + immunochemotherapy. Thirty-three patients were treated with megavoltage irradiation (cobalt-60), 11 with combinations of brachy therapy (2, Ra; 2, Cs; 7, Au grain) and megavoltage irradiation, and 1 with Cs only. Twenty-four patients were successfully treated with adjuvant chemotherapy (14, Bleomycin; 4, 5-Fu; 6, B-M therapy) and/or received immunotherapy (15, OK-432;9, PSK) combined with radiotherapy. The total cumulative 5-year survival rate was 40.6%; 12 of the 35 Stage IV cases were given multidisciplinary treatment, and their 5-year cummulative survival rate was 56.3%. Nineteen patients underwent surgery: 13 had marginal mandibulectomy, 5 had hemimandibulectomy, and 1 had segmental mandibulectomy. From our retrospective study, it was concluded that multidisciplinary treatment is excellent therapy for advanced carcinoma of the alveolus and gingiva.

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Data from the Japanese bone marrow transplantation (BMT) registry, which is based on 667 BMT patient records at 38 participating hospitals from 1975 through 1987, shows that the number of BMT cases increased annually from 1981. BMT treatment of leukemia has progressed rapidly during the last 10 years. Changes in patient selection criteria as well as treatment modalities, such as fractionated total body irradiation (TBI) and the selection of platelet donor with negative cytomegalovirus titer, heve significantly improved survival rates and decreased the incidence of interstitial pneumonitis since 1981. A national TBI survey confirmed that the most widely adopted TBI dose schedule was 12 Gy in 6 fractions over 3 days with a median dose rate of 6 cGy/min. Twenty-seven out of 32 hospitals adopted the traditional regimen, specifically, chemotherapy followed by TBI. However, the other 5 hospitals chose to use TBI preparation regimen first, followed by chemotherapy. TBI was found to be a more significant factor than chemotherapy in determing the time required for the white blood cell count to reach a minimum. Also, when TBI regimen proceeds chemotherapy, a bioclean environment is not needed for the patient during irradiation treatment.

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Although there are many ways to irradiate the total body, it is very difficult to obtain a homogeneous radiation dose distribution to the total body. We have developed a new irradiation technique, the so-called moving couch method. In our hospital almost all patients have received total body irradiation (TBI) with this moving couch method. This method has many advantages, for example, the patient can be easily positioned, dose distribution is homogenous and patients can be treated in the supine position without discomfort. From the beginning of 1982 to the end of 1988, we treated 49 patients using this TBI method. Another 7 patients were treated by the fixed large field method at long SAD (Source Axis Distance). All patients received fractioned TBI with doses of 6 Gy to 12 Gy. The average treatment time was about 15 minutes and the mean dose rate was about 14 cGy/min. To date, there have been no patients who have developed any severe complications as a result of TBI and no patients have died of radiation induced pneumonitis. Patients who are not malignant are all in good condition. In this paper, we also discuss the results of bone marrow transplantation (BMT) as well as the treatment schedule of BMT.

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A randomized clinical trial was performed in order to evaluate the effect of combined hyperthermia and radiation for superficially located tumors. Ten institutions participated in this study and 92 evaluable patients were entered from September 1985 to March 1987 (44 patients for radiation plus hyperthermia and 48 for radiation only). Superficially located tumors, more than 3×3 cm in diameter, regardless of whether they were primary or metastatic, and of their histology, were included in the study. Radiotherapy was performed by the conventional fractionation method (2 Gy×5/week). Hyperthermia was conducted once a week. There was no statistical difference between the two groups regarding age, sex, the distribution of tumors and treatment parameters. The complete response (CR) and partial response (PR) rate for the hyperthermia plus radiation group was 81.8%, while the rate for the radiation alone group was 62.6%(p<0.05). Six factors were selected for analysis of the above effect by a multiple logistic model. Sex contributed the most (p=0.001), then the site of the tumor (p=0.016) and the method of treatment (p=0.023). Sex and the site influenced the results. Age, irradiation dose and frequency and duration of heating were not significant factors for response to treatment.

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